Volume 83,
Issue 5,
2016

What you can expect from Piece - When (if) you read this column, you'll notice that there are times when I comment on what people have written, and there are times when I don't. There are other times when I focus on meetings that I have attended, or perhaps there are just random thoughts about things that strike me as being important, funny or sometimes possibly just interesting to me. The answer to "What are you going to write about this month?" is usually "It depends". I certainly don't feel the urge to comment on every single thing in the SAPJ, and there are many times when I adopt a wait and see attitude - if it's important to you, you'll write to me. That is an essential aspect of the journal. It's here to inform you, to provide material for CPD, and to give you a platform to air your views. My views are really not important in your daily life.

Life expectancy in South Africa, as in the world, is increasing and it is well known and generally accepted that older people put more pressure on the healthcare system and spend significantly more on healthcare than adolescents and adults. Add to this the triple burden of disease and significant increase in non-communicable disease with aging,and the increased expectations and pressure on a limited healthcare system is clear. Cost effective and efficient healthcare services are thus critical. From various studies and publications it has become evident that how patients follow prescriptions and adhere to treatment is at least as important for the outcome as the appropriate diagnosis and therapy. This is then also the reason why many countries have turned towards pharmacy for a more active role in health outcomes than the basic distribution or dispensing of medicine.

Cough mixtures are frequently prescribed for cough associated with upper respiratory diseases. Many different cough mixture combinations are available making an informed, therapeutically sound choice challenging for the pharmacist. Supportive evidence on the efficacy of cough mixtures in the alleviation of symptoms of colds and flu is not yet convincing. This review article aims to provide the pharmacist with knowledge and skills to make an appropriate informed choice of drug, individualised for the right patient, at the right time.

About 60-80% of patients visiting a pharmacy have at some stage in their lives suffered from low back pain. The annual incidence in adults aged 35-55 years in developed countries is up to 45%. The differential diagnosis is broad and includes muscular strain, primary spine disease like disc herniation or degenerative arthritis, systemic diseases like metastatic cancer and regional diseases like aortic aneurisms. In the majority of cases, a specific diagnosis cannot be made. Most patients will improve in 1-4 weeks and will only need treatment for the acute symptoms after the initial history and physical examination. If, however, the pain recurs or worsens, the patient must be thoroughly examined and a specific diagnosis can become a challenge.

The anxiety disorders, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are common and debilitating, often coexist with medical and psychiatric conditions, and usually require long-term treatment. Effective anxiolytic drugs include the selective serotonin reuptake inhibitors (SSRIs) and the serotonin and noradrenaline reuptake inhibitors (SNRIs), which are the preferredagents in primary care. Patients who fail to respond adequately to these may benefit from second-line tricyclic antidepressants or monoamine oxidase inhibitors. Alternative antidepressants include agomelatine and mirtazapine. Benzodiazepines, the anti-epileptic agent, pregabalin, and atypical antipsychotics are generally reserved for specialist use. The 5-HT1A agonist, buspirone, and the antihistamine, hydroxyzine, may also be useful, although the evidence for their efficacy covers a very narrow spectrum. This review describes the pharmacology of these anxiolytics and provides updated evidence for their use in the anxiety and related disorders.

SAAPI had a very eventful first and beginning of a second quarter of 2016! We started the year with a strategic session, where we discussed what we envisage for the future of SAAPI. We realised that it is a challenge and a half that is going to keep us busy for a long time! The objective we set ourselves for the year is to give tools to pharmacists in industry to be an empowered leader and ultimately be the decision maker. With the inherent knowledge of pharmacists, we felt that our skills are often underestimated and the value of the pharmacist is not always recognised in the decision making process in a corporate environment, or by the time we are invited to the decision making process, it is often too late and we end up having to do damage control rather than creating preventative measures by continuous improvement of our systems and procedures.

This year the SAAHIP Conference workshop introduced delegates to current challenges and innovations related to improving access to and use of medicines for chronic non-communicable diseases (NCDs) in South Africa. This topic is of relevance to pharmacists working in hospitals and institutions in a variety of settings in both the public and private sectors across South Africa.

I recently read an article about a wagtail, who saw himself in a car's side mirror and started fighting with himself. The bird would fight until it was out of breath and then go sit in a nearby tree for a minute or so, only to fly back and continue the fight. Quite comical, isn't it? Apparently it is a known phenomenon and at times the birds continue fighting untilt hey die of exhaustion.

The Foundation for Pharmaceutical Education (FPE) is administered by the PSSA. It receives, allocates and distributes bursaries to undergraduate and post graduate students who meet the criteria of the donors. A major area of concern is that the donations to the FPE cannot meet the needs of all applicants, who far outnumber the number of bursaries available. The amounts that can be allocated to bursaries is also generally lower than what the students need. The FPE would however like to thank all of the sponsors for their continued commitment and support - you are making a difference in a student's life.

The 66th Annual General Meeting (AGM) and 1st National Symposium for community pharmacists of the South African Association of Community Pharmacists (SAACP) took place at the Birchwood Hotel and Conference Centre in Boksburg, Gauteng on 13 and 14 May 2016. More information, including the presentations by various speakers at the symposium and photos taken of the gala dinner event, is available at www.saacpsymposium.co.za. Traditionally, as with most AGMs, this AGM was a very business orientated event. It was therefore decided to schedule the AGM to coincide with the 1st National Symposium for Community Pharmacists in South Africa and thereby provide additional motivation for members to attend the AGM.

At the 66th Annual General Meeting of the South African Association of Community Pharmacists (SAACP), the Julius Israelsohn Award was bestowed on Gary Michael Köhn for his dedicated, unstinting and exemplary service to the pharmacy profession, in particular the community pharmacy sector.

It is with sadness that I convey the news of the passing of Michael (Spike) Rubin. He was a friend and pharmacist of longstanding, maybe better known to pharmacists of my age!I will always remember him for his cheerful disposition and enthusiasm. He filled many roles during his years in Port Elizabeth. His major focus was on independent community pharmacy and owned a number of pharmacies over the years.